Total 108 resection cases of primary organ malignancy with local LN clearance were found as per archival records in a retrospective 1-year study. Slides and blocks of 8 cases were unavailable and hence total 100 cases were included in this study. Age, gender, tumor stage of primary organ malignancy, total LNs dissected per case, and LN sizes were accessed from surgical histopathology records. Slides were reviewed to evaluate LNM and LNR was calculated per specimen.

LN reactive hyperplasia was categorized into following morphological patterns:[2]

All data were recorded in MS Excel sheet. The statistical analysis was done using MS Excel and SPSS software. Association between qualitative variables was assessed by the Chi-square test and Fisher's exact test. Association between quantitative variables was done using unpaired t-test and Mann–Whitney U test.

Overall, pattern III was the commonest (60) followed by pattern II (46), pattern I (31), pattern IV (17), pattern VI (6), and pattern V (3) (P = 0.000). A mixed pattern was observed in 48 cases, commonest combination being pattern II and III (21). The commonest combination of pattern I was with pattern II (15) that of pattern IV was with pattern I (7), and of pattern VI was with pattern II (5).

Akagi et al. and Zeng et al. reported male predominance in colorectal and gastric carcinoma, as did Chen et al. in oropharyngeal malignancy.[3],[4],[5] Rubinstein et al. found 88.5% male preponderance in urinary bladder malignancies,[6] whereas we found a female preponderance. The male predominance in GIT and HFNT malignancies may reflect lifestyle-related behavior as alcoholism, processed junk food, smoking, and tobacco chewing. The peak age groups of malignancy were a decade younger compared to other studies.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12]

Lymph node harvested

The recommended LNH values are 10, 12, 12, and 40 in breast, GIT, GUT, and HFNT, respectively.[13],[14],[15],[16] It varies from 10 to 23 in breast cases[8],[13] and 18.5 to 28 in colorectal cancers.[4],[14] Koppie et al. found values 7.5, 8.6, and 14.7 in pelvic cancers over three decades.[17] Mean LNH for oropharyngeal cancers varies from 9 to 18[10] and 7.9 to 20[11],[12] for thyroid cancers. Techniques to further improve the yield of LNH include meticulous dissection during grossing, intratumoral India ink injection during surgery, ex-vivo intra-arterial injection of methylene blue, and chemical fat clearance using acetone and alcohol.[15],[18]

Dedavid et al. found mean LNR 0.15 as the best predictor of recurrence in colon cancer.[14] We observed higher LNR, possibly due to lowest LNH yield as also related to majority cases being in stage T3. Akagi et al. found recurrence rate of 64.9% in stage T3 in colon cancers.[4] Ninan et al. found pattern I commonest in non-metastatic cases and high tumor grade.[24] Zeng et al. found LNR to have high prognostic value in gastric cancers using cut-off points as 0, 0.5, and 0.8 to categorize low, intermediate, and high risk.[3]

Märkl et al. found 49.5% LNM in nodes <0.5 cm and 25% in >1.0 cm of colon cancers.[15] Burusapat et al. found mean size of positive nodes as 0.3 cm in oral cancers.[25] We observed metastases in small LNs up to 0.4 cm, while even LNs up to 3.0 cm showed non-metastatic reactive hyperplasia.

Koppie TM, Vickers AJ, Vora K, Dalbagni G, Bochner BH. Standardization of pelvic lymphadenectomy performed at radical cystectomy: Can we establish a minimum number of lymph nodes that should be removed? Cancer 2006;107:2368-74.